Provider Demographics
NPI:1396266722
Name:LONG, STEVEN RUSSELL (LPC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:LONG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2503 PILGRIMS POINT DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3227
Mailing Address - Country:US
Mailing Address - Phone:281-332-5314
Mailing Address - Fax:
Practice Address - Street 1:211 E PARKWOOD AVE STE 208
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5387
Practice Address - Country:US
Practice Address - Phone:713-678-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional